Lessons from Global Health Development: Insights from Four Change Models

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By Rob Thames

This is Part 3B of this three-part series.

Part 3A briefly reviewed four change methods. This Part 3B compares them to elicit insights. 

Motivational Interviewing, Kotter’s 8-Step Model, Baldrige Communities of Excellence, and SEED-SCALE, reviewed in Part 3A, were selected to reflect and reveal the wisdom of a range of disciplines, applications at different levels (individual, organizational, community and population) and purposes to aid change practitioners in the thinking and doing of their craft. How can comparing these models elicit deeper insights to affect sustainable change sooner and better?  

Some Questions for Cross-Benefit

Organizational leaders are inclined to plan and motivated to implement. How can leaders apply the individual-based MI change process, especially its relentless focus on the “why,” to better empower others to engage in large-scale challenges? 

Organizational leaders and MI counselors are tempted to pursue short-term results over long-term empowerment and are challenged to sustain progress. How can they employ the iterative, escalating scaling process and longer-term, biologic view of SEED-SCALE to advance in a manner that harnesses the human energy of self-direction and local ownership? 

Global health developers embrace the organic and biologic nature of long-term progress … and sometimes struggle with the patience for progress-by-the-decade. How might they help employ Kotter’s guidance to create a sense of urgency and shared vision to better empower local populations to pursue progress sooner? While the collective impact philosophy is inherent in SEED-SCALE, how could a stronger organizing framework like Baldrige better engage leaders across a breadth of stakeholders? 

Spread & Scale

A constant challenge for change practitioners is how to spread or grow the change. Studies estimate that a peer-reviewed established best practice in medicine takes about 17 years to spread. Taylor references four different approaches to scaling for growth. The first is Additive, which involves simply repeating the change, possibly from an original pilot. The Blueprint method involves a design created by experts, reflective of a centrally planned approach. The Explosion approach is best for addressing temporary, specific needs to solve a one-time problem quickly, e.g., when a community faces a crisis such as a flood or epidemic. Each of these three approaches presumes that communities are unlikely to initiate change on their own; control is ceded. The fourth approach, termed Biological, shares control from the beginning, and ownership remains dynamic. It combines the advantages of the additive model which begins slowly and adapts to the situation, with the speed and potential reach of the other two models. Its characteristics include exponential (emergent) growth; healthy, integrated relationships that fit the context; and ‘tensegrity,’ biology’s form of building by balancing systems in a flexible state of equilibrium. 

The chart below is an attempt to compare and convey key elements of the four change methods.

Disclaimer: The brief descriptors in the grid do not do justice to any of the models but are intended to offer relative characteristics for quick comparison and reference, as well as to encourage further study.

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So What?

What can we draw from these four change models?

  1. Benefits: While none of the methods is inherently “right” or wrong, all of the methods offer insight, perspective and promise; elements of each can be useful.

  2. Differences: Each method was developed for a different purpose and context that must be considered for potential application.

  3. 3.      Similarities: All deal with and strive to affect behavioral and social change/improvement.

As Taylor notes, in a rephrase of Aristotle, development is not the end we are seeking, but the process to seek something else.